Resiliency Inspiring, But Health Needs Persist in Puerto Rico

Dr. Elisabeth Poorman (pictured above holding the green medical bag) is a physician in Everett, Massachusetts. She traveled to Puerto Rico in November to support Project HOPE’s emergency response to Hurricane Maria.

Over the past few months, I felt the worst kind of déjà vu: hearing reports about Puerto Rico and remembering the devastation to my father's home town, New Orleans, which was devastated 12 years ago by Hurricane Katrina, and still bears its own scars.

Tired of bad news, I found myself googling volunteer opportunities, and left for a ten day medical mission with Project HOPE in Puerto Rico.

Weeks after the hurricane, over 90 percent of the island did not have power. By the time I arrived, the situation had improved dramatically, but unevenly. In some places, it was like nothing had happened. The mall in Ponce was up and running, indistinguishable from any other mall in America with a large Christmas display. Then a block later all the lights would be out. Up in the mountains, many were still gathering water in buckets to drink.

Everywhere we went, there were humanitarian groups, civil servants, and ordinary Puerto Rican citizens keeping calm and carrying on. The physicians, nurses, and other health care workers were working valiantly, and family members were extending themselves to take care of the most vulnerable.

On my last day in Puerto Rico, I traveled with Orlinda, a nurse who has spent her retirement going on trips like these, to visit patients who were unable to leave their homes. We were accompanied by two men from a church down the road who had a list of the 120 neediest patients.

I knew I would only be able to see a few before it got dark, and I was already exhausted, having seen 90 people with another doctor at a health fair in a soccer stadium that morning.

When we first got out of the car, I thought it was a mistake. The house was beautiful. The hostess was well-dressed with every hair in place. She could be 80, but looked timeless thanks to her immaculate appearance, straight posture and easy smile. “Aquí está el paciente,” she said, as she wound her way through darkened rooms.

It was cool, even though they didn’t have power like the rest of the neighborhood. A storm earlier in the day had cut into the heat, but also made the roads harder to pass. I noticed mud on my shoes as we stepped across her scrupulously clean floors.

In one room there was an old man at the end of his life, lying flat in a hospital bed which did not have power to help lift him up. “My husband,” the woman said, “had cancer and is very sick.”

His limbs were contracted and covered with a fresh blanket. His cheeks were sunken and his eyes were far away. He seemed overwhelmed by the commotion but didn't say anything. He turned away and faced the wall.

His wife rattled off his accomplishments and ailments, weaving them together as if all episodes of his life were happening at once.

She showed me a picture of her husband, a veteran, from the days before he shipped to Korea. He was a handsome man. In the photo, he had a look of optimism that reminded me of my grandfather’s Navy photos when he was just a boy in a uniform, and didn’t know what awaited him on the other side of the world. My own grandfather had died peacefully, having served his country and his family, his pain eased tenderly by the most compassionate caregivers.

This man was in pain. He hadn’t moved his bowels in days. He was refusing most food. I asked if he had been out of bed recently. “The nurse is gone, we can’t get him out,” his wife said. “She left before the storm and she hasn’t been back. We’re waiting.”

She couldn’t lift him out, and her grandson who came to help had fractured his leg. Somehow she had managed to take care of her husband, but she was petite and elderly herself, sharp of mind, but incredibly vulnerable.

I got on my knees to try to talk to her husband. He responded very little. I took his hand.

“Are you in pain?” I asked. He shook his head no. “Can I examine you?” He nodded. I removed the blanket piece by piece, careful to keep him covered. He had been well-cared for in spite of everything, his skin clean and intact. His lungs were clear, his belly was flat and soft.

Finally, he met my eyes and I said, “Sir, it seems to me you are doing well, but being stuck in the bed, for an active man like you, is very hard. And you seem a little depressed?” He nodded, almost imperceptibly.

“Would you like to go outside more?”

As soon as I finished the question he grasped both my hands, pulled his shoulders off the bed, his face almost touching mine, and blew air hard to say “Sí!”

I turned to his wife and we tried to brainstorm. She only had a few family members near. Her church hadn’t visited. They are waiting for the nurse, but there was no telling if the nurse would ever come back. Outside I asked the men from the church to try to visit and help him get out of bed at least once a week.

When patients are at the end of their life, it is an opportunity to step back from the day-to-day accounting, to take stock of their lives, to try to let them know that they are loved, and attend to their most pressing needs. In disasters, too, we have a chance to step back, to think about what happened and how we can do better next time, to consider what would make an effective meaningful response to future tragedies.

I told the man's wife over and over how remarkable she was, what a beautiful job she had done taking care of her husband.

We looked at the bottles by the bed. I clarified which medicines she could give more of, and which she should cut back on. We also talked about how he could eat what he wanted and refuse what he didn’t at this stage.

I thanked her for her hospitality. I wrapped my hands around the patient again. I thanked him for his service. He mouths “gracias.” I’m grateful to have been let in.